Chromoblastomycosis in a resident of a leprosarium.

Chromoblastomycosis is caused by dematiaceous fungi. It develops after inoculation of the organism into the skin. The lesion begins as a pink, scaly papule or warty growth. We report a case of chromoblastomycosis occurring in a multibacillary leprosy patient, who had already been released from treatment (RFT). The diagnosis was confirmed by the presence of sclerotic bodies (Medlar bodies/copper penny bodies). Systemic antifungal treatment has been found effective. The case is being reported in view of the association of two diseases and the dramatic clinical response to systemic treatment with Itraconazole.

Case of chromoblastomycosis appearing in an Okinawa patient with a medical history of Hansen's disease.

Chromoblastomycosis is one of several chronic infectious skin diseases caused by various species of dematiaceous fungi. It is clinically characterized by verrucous skin eruptions and occurs most commonly in tropical and subtropical regions. In Okinawa, a subtropical area, there have been only three reported cases of chromoblastomycosis including the present one. Direct microscopic examination of crust specimens and findings of sclerotic cells in histopathology can confirm the diagnosis, and cultures of crust and/or tissue specimens can identify the causative fungi. We herein report the third case of chromoblastomycosis in Okinawa; it arose in an 87-year-old Japanese woman with a history of Hansen's disease, who lived in a leprosarium in Miyako Island. To identify the causative agent as Fonsecaea pedrosoi, we used the polymerase chain reaction and direct sequencing analysis in addition to the usual methods, which include 20% potassium hydroxide microscopy, histopathological confirmation of sclerotic cells by periodic acid-Schiff stain, culture by Sabouraud's glucose agar, slide culture method, and observation of conidia by scanning electron microscopic examination.

Lymphangitic chromoblastomycosis.

Chromoblastomycosis (CM), a chronic subcutaneous mycosis, is caused by several dematiaceous fungi, the most common being Fonsecaea pedrosoi. It usually occurs in the lower extremities following traumatic implantation of the organisms. We are reporting a case of chromoblastomycosis on the right lower limb in a sporotrichoid pattern caused by F. pedrosoi. The pattern was probably due to lymphatic spread that seems to be one of the rare presentations. The histopathology showed typical muriform or medlar bodies both intracellularly and extracellularly within the granuloma. Culture revealed sporulating organisms (Cladosporium and Rhinocladiella type) by a combination method, characteristic of F. pedrosoi. Our case responded well to itraconazole.

[Squamous cell carcinoma arising from chromomycosis. Report of two cases]. / Carcinome épidermoïde développé sur des lésions de chromomycose. A propos de deux observations.

Madagascar is the principal area of endemic chromomycosis in the world with 1 400 cases registered from 1955 to 1996. Malignant transformation is rare and only 12 cases have been reported. We describe herein two new cases of squamous carcinoma arising from chronic lesions of chromomycosis. These carcinomas which develop slowly and are non invasive, are similar to those arising from burns, tropical phagedenic ulcers and chronic leprosy ulcers. Epidemiological aspects, histopathology and treatment are described.

Associaçäo de cromoblastomicose e hanseníase: relato de dois casos / Chromoblastomycosis associated with leprosy: report of 2 cases

Ao estudar 30 casos de cromoblastomicose diagnosticados no Hospital dos Servidores do Estado do Maranhao, no período de novembro de 1988 a março de 1993, os autores observaram 2 (6,6 por cento) casos, que apresentaram associaçao desta doença com hanseníase. O primeiro paciente desenvolveu as duas doenças concomitantemente, apresentando espessamento no nervo cubital bilateral, mal perfurante plantar em pé direito e lesoes em placas verrucóides na perna esquerda, com biópsia de nervo cubital direito positiva para hanseníase dimorfa T e biópsia da lesao em placa, positiva para Fonsecaea pedrosoi. O segundo caso, paciente com história de hanseníase virchowiana há 30 anos, em pausa terapêutica por "cura", com lesoes verrugo-confluentes em cotovelo direito há 12 meses, histopatológico e cultura positiva, para cromoblastomicose. Os possíveis fatores para o desenvolvimento da cromoblastomicose nestes pacientes sao discutidos.

[Chromoblastomycosis associated with leprosy: report of 2 cases]. / Associação de cromoblastomicose e hanseníase: relato de dois casos.

Thirty cases of chromoblastomycosis were diagnosed at Hospital dos Servidores do Estado do Maranhão, from November, 1988 to March, 1993. The authors report 2 (6.6%) cases, that presented an association with leprosy. The first patient developed both diseases together, showing palpable bilateral cubital nerves, perforanting ulcer of the right foot, infiltration and lesions in verrucoid plaques in left leg, with positive biopsy for dimorphic leprosy. The second case, a patient with history of lepromatous leprosy for 30 years without treatment, with vegetant lesions with a warty aspect in right elbow for 12 months, histopathologic and positive culture for chromoblastomycosis. The possible factors for development of this disease in these patients are discussed.

Chromoblastomycosis in a residual patch of leprosy.

A middle aged male who had adequate dapsone monotherapy for borderline tuberculoid leprosy developed chromoblastomycosis within the residual analgesic patch during the post-treatment follow up period. Cladosporium carrionii, the causative fungus was isolated from culture in Sabouraud's agar. There was prompt therapeutic response to oral ketoconazole. The possible factors for development of chromoblastomycosis in this patient are discussed.

Hanseníase tuberculóide reacional com lesões verrucosas

Relatam os AA. a observação de paciente do sexo masculino, de 27 anos, preto, portador de lepra tuberculóide reacional, com lesões localizadas na face, de aspecto nitidamente verrucoso. Nos antecedentes mórbidos há referência à tuberculose pulmonar ainda em tratamento e na vigência da qual ocorrem as lesões da lepra T.R. Fazem o diagnóstico diferencial com a tuberculose verrucosa que pode ser afastada cl¡nicamente e pela histopatologia que foi compatível com o diagnóstico de lepra tuberculóide reacional com lesões verrucosas. Na revisão de literatura encontraram apenas 6 trabalhos referentes à lesão verrucosa no mal de Hansen, sendo o presnte, o primeiro referido com o tipo tuberculóide reacional.

Cromomicose e lepra: apresentação de 2 casos

Os AA. apresentam 2 casos de cromomicose associada à lepra, num dos quais conseguiram isolar o fungo causador da moléstia que foi identificado como Phialophora pedrosoi. Comentando a literatura mundial sôbre o assunto e ausência de diagnósticos desta associação nos principais Institutos de Pesquisa sôbre Lepra, do pa¡s, salientam a necessidade de pesquisas mais sérias para apurar as causas da raridade desta associação.